Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery.

Item does not contain fulltextOBJECTIVES: Repeat sternotomy is associated with a substantial risk of cardiovascular injury. We evaluated the feasibility and clinical outcome of a transabdominal approach without sternotomy and without cardiopulmonary bypass in repeat coronary artery bypass grafting, using the right gastroepiploic artery to graft vessels of the inferior wall of the heart. METHODS: From July 1999 to October 2010, 22 patients presenting with only right coronary artery disease underwent reoperation using the transabdominal approach and a skeletonized gastroepiploic artery graft. In all patients but 1, a patent graft to the anterior wall was present. The mean EuroSCORE was 6.4 +/- 2.5. RESULTS: All patients had adequate surgical exposure, and no conversion to sternotomy or the use of cardiopulmonary bypass was required. There was no in-hospital mortality. Hospital morbidity included pneumothorax in 1 patient and atrial fibrillation in 2 patients. The median hospital stay was 5 days. Follow-up was complete, and the median follow-up time was 6 years. There were 2 late deaths. Four patients experienced recurrence of angina, of whom three required percutaneous coronary intervention. The estimated freedom from major cardiovascular and cerebrovascular events rate was 70.2% at 6 years. Fourteen patients underwent an exercise stress test at a median interval of 2 years, with all showing no signs of myocardial ischemia. CONCLUSIONS: Transabdominal off-pump coronary artery bypass grafting using the right gastroepiploic artery is a safe and effective procedure with low in-hospital mortality and morbidity and favorable mid-term outcome. In redo operations, this technique excludes the risk of cardiovascular injury.1 juli 201